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Colorado's rural health services bleeding money in new, old ways

Intermediate technician Carla Hanson, right, prepares one of the ambulances for service. Summit County Ambulance has needed frequent infusions of subsidies from Summit County government in order to keep operating because of threatened cost cuts and falling uses from ambulances to small hospitals. (Kathryn Scott Osler, The Denver Post)

The hospital in Rangely is threatening to cut off ambulance service to the western half of a remote neighboring county.

An Eastern Plains hospital is struggling for survival and asking the state for rescue plans.

Small hospitals in the San Luis Valley are merging to ward off financial dangers.

A new round of crises and challenges in rural Colorado medicine has health experts and public officials on alert, scrambling to shore up services in far-flung areas. While metro hospitals thrive and compete by adding perks, small providers in the country are patching holes.

"How do we keep some level of care, even if it's just stabilizing care, in these very small communities?" said Randy Kuykendall, interim director of EMS for the Colorado Department of Public Health and Environment. "It's an ongoing battle."

Fast-aging rural communities rely more on Medicare payments, which are being trimmed by the sequestration and other measures. Small hospitals must work harder to recruit doctors and other providers who can bring in revenue. Ambulances see declining payments from Medicare and Medicaid, with rising costs for fuel, equipment and staff benefits.

Counties, towns and strapped hospital districts are trying to stay creative as they adapt or die:

• The Rangely District Hospital, in Rio Blanco County in the far northwest corner of the state, told Dinosaur and other small towns in next-door Moffat County it could no longer extend ambulance service.

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Moffat County towns Craig and Maybell have their own ambulance services for the eastern and central parts of the sprawling county. But they are 90 and 60 miles away, respectively, from Dinosaur and other communities close to the Utah border.

"When you need an ambulance, 90 minutes later is not when you need it," said Tom Soos, Moffat County's emergency services director.

• The 12-bed hospital in Cheyenne Wells near the Kansas border put out an open call to the community in the spring on whether the hospital should stay open, citing new costs for everything from minimum staffing levels to a new sprinkler system.

"That hospital is struggling," Kuykendall said.

The hospital, Keefe Memorial, asked the state to help with a rare review of local emergency services. The state allows a licensure category below a full acute-care hospital, calling it a "community clinic" with emergency services. The town and the county will have to decide what they can live with, Kuykendall said.

• Ambulance companies in small towns are giving up independence in the face of declining Medicaid payments, the high cost of diesel on long runs and other pressures.

Logan County in northeastern Colorado lost a private ambulance service in late 2011. The fire department in Sterling, the largest city in the county, took over ambulance services for the region.

Morgan County, next door, has a county-sanctioned ambulance service that gets no tax money and has talked openly of budget struggles. Survival there is "year to year," the director said, but officials have given up the idea of a new taxing district to create more stable financing.

Summit County's ambulance service has run an annual deficit averaging $460,000 in recent years, with county commissioners making up the gap. Officials in the mountain county have reduced emergency staffing and are considering a county sales tax and other measures to shore up the budget.

• Two small hospitals in the San Luis Valley of southern Colorado merged this month to create a stronger system, with greater immunity to the financial problems besetting other rural institutions.

The former Conejos County Hospital in La Jara and San Luis Valley Regional Medical Center in Alamosa merged to encompass two hospitals and five clinics.

The two already cooperated in many areas before making the merger official July 1. The Alamosa hospital already had forged a partnership with the Centura group of hospitals, based in metro Denver, to send specialists to the valley more often.

The valley can't afford hospital closures — Alamosa is the only hospital delivering babies for six counties.

"We're certainly feeling all of the stresses happening in the marketplace, we're just a little bit bigger and a little more diverse," said Konnie Martin, chief executive of the merged hospitals. "And that's held off those stresses compared to a smaller hospital."

Occasionally, a small hospital scores a win that keeps it out of trouble, at least for a time — sometimes with a simple hire or two.

Melissa Memorial in Holyoke, like many small-town facilities, was desperate to attract full-time physicians and other medical personnel. Last year, it spent tens of thousands of dollars producing an upbeat, "welcome to Holyoke" video and hoped it would get circulation.

Chief executive John Ayoub said the video was part of a more optimistic spirit that helped the town get what it needed. The hospital sent the video to candidates with serious interest, to make sure they knew what the town was like before they traveled for an interview.

In nine months, Melissa has hired an M.D., a doctor of osteopathy and a nurse practitioner, Ayoub said. The hospital is in the black but took a hit along with other hospitals when the federal sequestration shaved Medicare payments.

The town is working on an agreement to replace Rangely's ambulance with services from Vernal, 34 miles away in Utah.

Moffat County commissioners still worry about even smaller towns, such as Elk Springs, which are beyond the Maybell service and not included with Dinosaur. They will meet with Rangely hospital officials before the Aug. 31 deadline to talk about solutions, said commissioner Chuck Grobe.

"They were pretty blunt in their letter," Grobe said. "We'll do what we can, but the bottom line is, we don't have the funds."

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